Join Dental Protection

Free Dental Student Membership Application Form

I wish to become a Dental Student Member of Dental Protection under the Terms of the Memorandum and Articles of Association of the Medical Protection Society.

Please complete the form below and click submit

Title:

Surname:

Forename:

Date of birth (dd/mm/yyyy):

Gender:

Dental school:

Course year:

Email address:

Confirm Email address:

Home address:

Postcode:

Term-time address
(if different to home address):

Postcode (term-time address):

Preferred mailing address:

Telephone number:

Mobile number:

Have you ever been cautioned by the police, or do you know of any other issues that Dental Protection might reasonably wish to be aware of when considering your application? (If in doubt please tick Yes). Please note your declaration is confidential and will only be used to enable us to offer you appropriate advice, professional support and guidance.

YesNo

If you require any advice or assistance completing this form, please contact the Student Helpline on 0845 900 0022

DPL will not pass on your details to any third parties, as set out in our privacy policy

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Dental Protection Limited (registered in England No. 2374160) is a member of the Medical Protection Society Limited (registered in England No.36142) group of companies. Both companies have their registered office at 33 Cavendish Square, London W1G 0PS. MPS is not an insurance company. All the benefits of membership of MPS are discretionary as set out in the Memorandum and Articles of Association